In the waning days of 2016, Congress passed the 21st Century Cures Act with a 392-to-26 vote in the House and a 94-to-5 vote in the Senate. While it wasn't without controversy, it was a show of bipartisanship rarely seen in recent years. The bill allocates $1.8 billion to fund development of new cancer cures, $1 billion to bolster the fight against the current opioid epidemic, and includes provisions that should ultimately increase the availability of behavioral health services.
Over the past decade, my immediate family has waged our own war against cancer, opioid addiction, and mental health crisis, so I've personally witnessed their terrible wrath. I commend Congress' dedication to improving our health care services so these diseases, and many others, are ultimately less destructive to our communities. However, better health care services are only useful to people who have access to health care. Persistent and significant disparities exist across race, income, and geography in access to cancer treatment, prescription drug use, and access to mental health services. Too often, these disparities are exacerbated by a lack of health insurance.
At the same time Congress was working to pass 21st Century Cures, congressional leaders were working behind the scenes to craft a strategy for immediate repeal of the Affordable Care Act. By every analysis, repeal of the ACA without replacement would lead to millions more uninsured, higher health care costs, and dramatically less access to the very health care services that 21st Century Cures seeks to improve - especially for those who need these services the most.
Repeal of the ACA seems imminent, but congressional leaders should insist on a responsible replacement plan to be enacted simultaneously. Any replacement plan must include the following:
Protection of coverage gains: Colorado, and the country, have seen historic gains in ensuring meaningful health coverage since the passage of the ACA. Protecting these gains in coverage, as well as the corresponding benefits of improved access for consumers and sustainability for health care providers, is a must.
Protection for our most vulnerable populations: Replacement plans must acknowledge the vital role that publicly funded programs play for so many people, including children, seniors, people of color, low-income individuals, and people with disabilities. Any plan should ensure a strong health care market through stable funding and federal oversight of comprehensive, affordable coverage.
Encouragement for health care transformation: Colorado has capitalized on opportunities to bring efficiencies and improvements to our health care system through collaboration in both private and public delivery systems, particularly by focusing on the integration of behavioral and physical health care. Replacement plans should continue to support transformation at the state and community levels with federal investment.
The ACA has not been perfect, but the impressive and important coverage gains it's led to are undeniable. Without health insurance, people delay seeking health care until the need is dire, which usually results in higher costs than if the person were able to access care early. They will also be unlikely to be able to afford follow-up care or medications they need to stay healthy, including treatments for cancer, substance use, and mental illness. 21st Century Cures requires an insured populace to fulfill its promise to the American people; if the ACA is repealed without a sufficient replacement that continues to enable access to vital health care services for the most vulnerable, it will have fallen far short of its potential.
Joe Sammen is the executive director of the Colorado Coalition for the Medically Underserved. He serves on the steering committee of the State Innovation Model, the Partnership of Academicians and Communities for Translation Council, and the Colorado Health Extension System.